Background
Antenatal corticosteroids improve neonatal outcomes when administered to infants who
are at risk of preterm delivery. Many women who receive antenatal corticosteroids
for threatened preterm labor proceed to deliver at term. Thus, long-term outcomes
should be evaluated for term-born infants who were exposed to antenatal corticosteroids
in utero.
Objective
This study aimed to compare long-term outcomes between term-born children aged ≥5
years who were born to women who received antenatal corticosteroids for threatened
preterm labor and children whose mothers were also evaluated for threatened preterm
labor but did not receive antenatal corticosteroids.
Study Design
We performed a retrospective cohort study of children born at ≥37 weeks’ gestation,
aged ≥5 years, and born to mothers diagnosed with threatened preterm labor during
pregnancy. The primary exposure of interest was receiving antenatal corticosteroids.
Among the collected childhood medical conditions, the primary outcome of interest
was a diagnosis of asthma.
Results
Of the 3556 term-born children aged ≥5 years, 629 (17.6%) were exposed to antenatal
corticosteroids (all betamethasone), and 2927 (82.3%) were controls whose mothers
were evaluated for threatened preterm birth but did not get antenatal corticosteroid
injections. Women receiving antenatal corticosteroids had higher rates of maternal
comorbidities (diabetes mellitus, hypertension; P≤.01). Antenatal corticosteroid-exposed children had no difference in diagnosis of
asthma (12.6% vs 11.6%), attention deficit disorder, or developmental delay (P=.47, .54, and .10, respectively). Controlling for maternal and neonatal characteristics,
asthma was not different between those exposed to antenatal corticosteroids and controls
(odds ratio, 1.05; 95% confidence interval, 0.79–1.39). The odds of the child’s weight
percentile being <10% were increased for antenatal corticosteroid-exposed children
born at term (odds ratio, 2.00; 95% confidence interval, 1.22–3.25).
Conclusion
Children born at term who were exposed to antenatal corticosteroids may have increased
odds of being in a lower growth percentile than those not exposed. However, rates
of diagnoses such as asthma, developmental delay, and attention deficit disorders
were not different.
Key words
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Article info
Publication history
Published online: July 21, 2022
Accepted:
July 14,
2022
Received in revised form:
July 14,
2022
Received:
February 21,
2022
Footnotes
The authors report no conflict of interest.
This study was funded, in part, with support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD088014 to D.M.H.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Support was also provided by the Indiana University School of Medicine Department of Obstetrics and Gynecology to the Indiana University Center for Pharmacogenetics and Therapeutics Research in Maternal and Child Health (PREGMED).
Cite this article as: Osteen SJ, Yang Z, McKinzie AH, et al. Long-term childhood outcomes for babies born at term who were exposed to antenatal corticosteroids. Am J Obstet Gynecol 2023;228:80.e1-6.
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ScienceDirect
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- A dilemma of antenatal corticosteroids for long-term consequencesAmerican Journal of Obstetrics & GynecologyVol. 228Issue 1
- PreviewAntenatal corticosteroids (ACS) are known to accelerate fetal lung maturation and prevent preterm neonatal mortality, respiratory distress syndrome, and brain injury. The American College of Obstetricians and Gynecologists has expanded its recommendations for the use of ACS to late preterm and early term deliveries.1 Under such guidelines, the proportion of infants who are exposed to synthetic corticosteroids has substantially increased. In the setting of a large infant population being involved, it is imperative to evaluate the long-term safety of ACS, especially after a population-based cohort study that reported a hazard ratio of 1.47 of any mental or behavioral disorder in children born at term who were exposed to ACS.
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